PHI for Self Insured Plans

[greggy]

New York

I found this clause in a plan document, does this mean my employer can use PHI for employment decisions? Sounds like they agree to act pursuant to an authorization which could be one of the documents they had me sign with broad legal language.

In order that the Plan Sponsor may receive and use PHI for plan administration purposes, the Plan Sponsor agrees to:

Not use or disclose PHI for employment-related actions and decisions or in connection with any other
benefit or employee benefit plan of the Plan Sponsor, except pursuant to an authorization which meets the
requirements of the privacy standards;


Thank you

 

[Zigner]

If you have specific questions about your plan, you should ask the plan administrator. Alternatively, you can have an attorney look at it. Contract review is beyond the scope of this forum...and answering a question based on a small snippet isn't wise anyway.

 

[Taxing Matters]

New York

I found this clause in a plan document, does this mean my employer can use PHI for employment decisions? Sounds like they agree to act pursuant to an authorization which could be one of the documents they had me sign with broad legal language.

In order that the Plan Sponsor may receive and use PHI for plan administration purposes, the Plan Sponsor agrees to:

Not use or disclose PHI for employment-related actions and decisions or in connection with any other
benefit or employee benefit plan of the Plan Sponsor, except pursuant to an authorization which meets the
requirements of the privacy standards;


Thank you

Businesses that self-insure for health insurance for their employees are generally bound to the privacy rules imposed by the Health Insurance Portability and Accountability Act (HIPAA). In order for other health care firms to make disclosures of PHI in some circumstances to the employer plan the employer has to commit to following those privacy rules, including shielding the disclosure of that information to others in the business that are not involved in administering the health plan. The paragraph you quoted may be part of that commitment.

But a key thing for you to know is that the employer plan can always make disclosure of your PHI if you authorize it in writing. The paragraph you quoted is not needed for the employer to do that. It could do that even if that paragraph was not there. You always want to read carefully and understand the documents your employer asks you to sign. If you sign without reading it you'll be hard pressed to complain later when the employer acts based on what you agreed to in the documents you signed.

 

[cbg]

Additionally, it is also important to know that not all medical information is PHI.

 

[FlyingRon]

I've never seen a self-insured company that didn't use a insurance provider to administer the plan. Even the larger companies don't have the resources to do that. The "self-insured" aspect is determined by where the MONEY to pay out the claims comes from. The employer doesn't see the details on the payments. As TM points out, even if they did, they do rise to become covered entities and have strict rules under HIPAA.